Retrospective study investigating naloxone prescribing and cost in US Medicaid and Medicare patients

• Published in: BMJ open Vol. 14; no. 5; p. e078592
• Main Authors: Manko, Christopher D, Ahmed, Mohamed S, Harrison, Lavinia R, Kodavatiganti, Srivastava A, Lugo, Noelia, Konadu, Jason Osei, Khan, Farrin, Massari, Carrie A, Sealey, Tenisha K, Addison, Maame Efua, Mbah, Celine N, McCall, Kenneth L, Fraiman, Joseph B, Piper, Brian J
• Format: Journal Article
• Language: English
• Published: England British Medical Journal Publishing Group 01-05-2024; BMJ Publishing Group LTD; BMJ Publishing Group
• Subjects: CLINICAL PHARMACOLOGY; Drug overdose; Drug Prescriptions - economics; Drug Prescriptions - statistics & numerical data; Drug stores; EPIDEMIOLOGY; Humans; Male; Medicaid; Medicaid - economics; Medicaid - statistics & numerical data; Medicare; Medicare - economics; Naloxone - economics; Naloxone - therapeutic use; Narcotic Antagonists - economics; Narcotic Antagonists - therapeutic use; Narcotics; Patients; Pharmacology and therapeutics; Pharmacy; Practice Patterns, Physicians' - statistics & numerical data; Prescription drugs; PUBLIC HEALTH; Retrospective Studies; Trends; United States; United States; South Dakota; Rhode Island; New Mexico; United States > US; PUBLIC HEALTH; CLINICAL PHARMACOLOGY; EPIDEMIOLOGY
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2023-078592

BackgroundOpioid overdoses in the USA have increased to unprecedented levels. Administration of the opioid antagonist naloxone can prevent overdoses.ObjectiveThis study was conducted to reveal the pharmacoepidemiologic patterns in naloxone prescribing to Medicaid patients from 2018 to 2021 as well as Medicare in 2019.DesignObservational pharmacoepidemiologic studySettingUS Medicare and Medicaid naloxone claimsInterventionThe Medicaid State Drug Utilisation Data File was utilised to extract information on the number of prescriptions and the amount prescribed of naloxone at a national and state level. The Medicare Provider Utilisation and Payment was also utilised to analyse prescription data from 2019.Outcome measuresStates with naloxone prescription rates that were outliers of quartile analysis were noted.ResultsThe number of generic naloxone prescriptions per 100 000 Medicaid enrollees decreased by 5.3%, whereas brand naloxone prescriptions increased by 245.1% from 2018 to 2021. There was a 33.1-fold difference in prescriptions between the highest (New Mexico=1809.5) and lowest (South Dakota=54.6) states in 2019. Medicare saw a 30.4-fold difference in prescriptions between the highest (New Mexico) and lowest states (also South Dakota) after correcting per 100 000 enrollees.ConclusionsThis pronounced increase in the number of naloxone prescriptions to Medicaid patients from 2018 to 2021 indicates a national response to this widespread public health emergency. Further research into the origins of the pronounced state-level disparities is warranted.